Supporting Facial Transplantation with the Pillars of Bioethics

Abstract

Facial transplantation has recently been offered to patients with severely disfigured faces not amenable to functional reconstruction with autologous tissues. Arguments against this procedure include risks of immunosuppression, the concern that it will be done for cosmesis, the belief that acceptable reconstruction can be achieved with autologous tissues, the potential impact on the patient of graft failure, and the concern that the procedure may be adopted by unqualified centers. If we look to bioethics to help us dissect the question of whether or not facial transplantation should be performed, we see that the majority of the arguments have been proscriptive rather than prescriptive. There are valid arguments in favor of facial transplantation based on the prescriptive pillars of bioethics: autonomy, justice, and beneficence. This article attempts to reframe the dialogue in a prescriptive manner.

Penis Allotransplantation in Beagle Dog

“…Therefore, we believe that if using a proper immunosuppressive regimen, penis transplantation could be ethical in selected cases. In a similar manner, disfigurement does not endanger life, but a recent bioethics analysis has shown that there are valid arguments for facial transplantation despite the risks associated with the procedure [ 31 ]. Similar arguments could be applied to penis transplantation.…”

Citation Classics in Nursing Journals

“…Several other ethical issues during the conceptual phase of facial transplantation were presented, which assessed whether the benefits of the procedure outweighed the risks including the risks of lifelong immunosuppressive therapy and potential medical complications (O'Neill, 2009;Powell, 2006;Renshaw et al, 2006;Wu et al, 2009), the ability to obtain a fully informed consent and assure patient autonomous decision making because of the innovative nature of the procedure (Reitsma & Moreno, 2006), the financial burden for such procedures absorbed by the healthcare system (Kalliainen, 2010), and situations whereby the patient might fail to comply with necessary treatment to preserve their transplant, which would result in a burden to the healthcare system, including subsequent surgical interventions and treatment. The participants in this study believed that the risks of long-term immunosuppression after a facial transplant, although concerning, were acceptable to them.…”

“…The complex issues include determining patient selection criteria (Butler, Clarke, & Hettiaratchy, 2005;Pushpakumar et al, 2010), refining donor tissue procurement techniques (Meninguad, Paraskevas, Ingallina, Bouhana, & Lantieri, 2008;Pushpakumar et al, 2010), predicting expected functional outcomes (Landin, Cavadas, Gonzalez, Rodriguez, & Caballero, 2008;Pushpakumar et al, 2010), appreciating the limitations of obtaining a fully informed consent for an innovative procedure (Hurlburt, 2007;King, 2002;Reitsma & Moreno, 2006;Renshaw, Clarke, Diver, Ashcroft, & Butler, 2006), and deliberating the immunological response and postoperative immunosuppressant requirements of the recipient (Petit, Paraskevas, Minnus, Lee, & Lantieri, 2004;Pomahac, Aflaki, Chandraker, & Pribaz, 2008;Swearingen et al, 2008;). In addition, psychological implications for the patient (Clarke & Butler, 2009;Morris et al, 2007;Swindell, 2006), societal consequences Kalliainen, 2010), and ethical concerns (Hurlburt, 2007;O'Neill & Godden, 2009;Renshaw et al, 2006) were identified.…”

Vascularized Composite Allotransplant in the Realm of Regenerative Plastic Surgery

“…In many cases, the graft cannot be removed without life-threatening consequences; as a result, the ethics of face transplantation have been extensively debated. 43,44 To date, 28 face transplants have been reported, and 3 additional transplants have been performed since that report. 11 Five-year outcomes of the first face transplant, performed in 2005, were recently reported.…”